CC License Research Articles

Racial and Ethnic Disparities in the Mental Health Impact of the COVID-19 Pandemic in the United States: Analysis of 3 Million Americans from the National Health Interview Survey and Household Pulse Survey

Background: During the coronavirus (COVID-19) pandemic, racial/ethnic minorities in the United States (US) experienced a disproportionate burden of COVID-19 mortality and hospitalization, job losses, food insecurity, and reduced healthcare access, resulting in increased mental health problems. Given heterogeneous findings on the impact of COVID-19 among racial/ethnic minorities, it is worthwhile to examine the differential effects of the pandemic on mental health by race/ethnicity. Methods: This study examines changes in mental health status among US adults aged ≥18 years before and during the pandemic. We pooled data from the 2019 National Health Interview Survey with the 2020-2021 Household Pulse Survey (N=2,980,511). Logistic regression was used for binary outcomes and linear regression was used for the composite Psychological Distress Index (PDI) measure derived from principal components analysis to estimate changes in mental health after controlling for sociodemographic characteristics. Results: Mental health status worsened during the pandemic compared to the pre-pandemic period. The adjusted predicted probabilities of having little interest increased from 3.29% in 2019 to 10.97% in 2020 and 11.28% in 2021. The adjusted predicted probabilities of being depressed increased from 2.69% in 2019 to 11.00% in 2020 and 11.21% in 2021. The adjusted predicted probabilities of feeling anxious increased from 3.95% in 2019 to 18.35% in 2020 and 16.96% in 2021. The adjusted predicted probabilities of worrying increased from 4.18% in 2019 to 13.15% in 2020 and 12.61% in 2021. The adjusted mean PDI score increased from 87.52 in 2019 to 103.18 in 2020 and 101.13 in 2021. In stratified models, Blacks, Hispanics, and Asians had higher odds of depression, anxiety, and worries, compared with non-Hispanic Whites. Asians experienced 10 times higher odds of depression and 15 times higher odds of anxiety in 2020 than their counterparts before the pandemic. Conclusions and Implications for Translation: US adults experienced a marked increase in mental health problems, including depression and anxiety, in 2020 and 2021, compared with their counterparts in 2019. Racial/ethnic disparities in mental health worsened during the pandemic. Copyright © 2022 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

A Narrative Review of the Pathophysiology of Mucormycosis Infection Among COVID-19 Patients in India: Epidemiology and Clinical Implications

Background and Objective: During the second COVID-19 wave in India (April to May 2021), mucormycosis has affected the ‘recovering’ and the ‘recovered but vulnerable’ COVID-19 patients across the country. This review synthesizes information on the risk factors and pathophysiology of mucor infection among COVID-19 patients, which in turn supplements existing information from public health and clinical sciences. The study objective includes analyzing the morbidity of mucor infection and its pathophysiological mechanism, during India’s second wave of the COVID-19 pandemic. Methods: We conducted a systematic literature search of PubMed and Google Scholar databases, using the following text terms: ‘COVID-19,’ ‘SARS-CoV-2,’ ‘mucormycosis,’ and ‘zygomycosis.’ We identified 24 citations and 16 other published literature which described mucormycosis in association with COVID-19. The relevant literature was analyzed for findings on the risk factors of mucor infection and its outcome among individuals with COVID-19. Results: The risk factors for mucor infection include diabetes mellitus, immunosuppression (for example, the administration of steroids/monoclonal antibodies/broad-spectrum antibiotics), prolonged stay in the intensive care unit, co-morbidities such as malignancy or post-transplantation, and prophylactic therapy with voriconazole (generic anti-fungal). The second wave of COVID-19 in India was more severe due to the increased occurrence of systemic inflammation and coagulopathy, which can cause direct damage to the blood vessels resulting in injuries to organs such as the liver, kidney, and heart. Conclusion and Implications for Translation: The increased incidence of mucormycosis during the second wave of the COVID-19 pandemic in India (April to May 2021) was due to a combination of immunocompromising effects of corticosteroids, microangiopathy of diabetes, and peripheral microthrombi among COVID-19 patients. The indiscriminate usage of steroids for treating COVID-19 disease seems to be the likely cause, including the use of immunomodulatory drugs such as interleukin 6 inhibitors like tocilizumab (TCZ) for patients with severe COVID-19. Clinical practices should adopt a judicious approach towards the prescription of steroids and monitoring blood sugar for all COVID-19 patients admitted to the hospital as well as those isolated at home (even during the post-recovery period). The high mortality rate of mucor infection demands appropriate primary prevention measures, as well as early diagnosis and treatment modalities for improving patient survival. Copyright © 2022 Ramani et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Editor's Preface

Bibliography: Bae, Sang Hoon: Editor's Preface, IJREE – International Journal for Research on Extended Education, Vol. 9, Issue 2-2021, pp. 249. https://doi.org/10.3224/ijree.v9i2.01 ----- Open Access License: This contribution is available in Open Access under the Creative Commons license CC BY 4.0 (Attribution 4.0 International) as of 16.05.2022. More information about the license and the terms of use can be found here .

Beyond the COVID-19 Vaccine: The “Epidemic” of Violence in Ghana and Strategies to Keep Women and Children Safe from Gender-Based Violence

Although the tides of the Coronavirus-2019 (COVID-19) pandemic are turning in some parts of the world, the pandemic has exacerbated abusive behavior towards women and children. In Ghana, West Africa, women and children stand a greater chance of experiencing aggravated levels of violence due to cultural considerations. In this commentary, we searched for papers using the keywords “(COVID-19) AND (violence) AND (women and children)” with refining limited to 01-01-2020 to 31-12-2020 on PubMed, Google Scholar, and other websites. A total of 17 and 20 papers from PubMed and other sources, respectively, were included. We found that violence against women and children has worsened in Ghana during the COVID-19 period. The findings call for the need to enhance or build women’s capacity to identify violence, enhance their exposure to available avenues of assistance, and resist the impunity of culprits. Also, the government should strengthen and adequately provide resources for human rights organizations mandated to protect the rights of women and children. Copyright © 2022 Nyaaba et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Time to go green?

Time to go green?

Developing a physical activity initiative for a community mental health service

Developing a physical activity initiative for a community mental health service

Web-based exercise therapy for the treatment of depression

Web-based exercise therapy for the treatment of depression

Editor's Preface

Bibliography: Bae, Sang Hoon: Editor's Preface, IJREE – International Journal for Research on Extended Education, Vol. 9, Issue 1-2021, pp. 3. https://doi.org/10.3224/ijree.v9i1.01 ----- Open Access License: This contribution is available in Open Access under the Creative Commons license CC BY 4.0 (Attribution 4.0 International) as of 07.04.2022. More information about the license and the terms of use can be found here .

A critical scrutiny and discussion of the significance of complementation and compensation viewed from different aspects of Extended Education in different countries

Bibliography: Ljusberg, Anna-Lena/Klerfelt, Anna: A critical scrutiny and discussion of the significance of complementation and compensation viewed from different aspects of Extended Education in different countries, IJREE – International Journal for Research on Extended Education, Vol. 9, Issue 1-2021, pp. 4-6. https://doi.org/10.3224/ijree.v9i1.02-----Open Access License: This contribution is available in Open Access under the Creative Commons license CC BY 4.0 (Attribution 4.0 International) as of 07.04.2022. More information about the license and the terms of use can be found here.

Prevalence and Sociodemographic and Behavioral Correlates of Psychological Distress among Lesbian, Gay, and Bisexual Adults in the United States, 2013-2018

Background: The lesbian, gay, bisexual, and transgender (LGBT) population comprises approximately 5.6% of the total US population. Levels and patterns of psychological distress in the LGBT population are less well known compared with the general population. This study examines the prevalence and sociodemographic and behavioral correlates of psychological distress among lesbian, gay, and bisexual (LGB) adults in the United States. Methods: Using the pooled cross-sectional data from the 2013-2018 National Health Interview Surveys (N=183,020), differentials in serious psychological distress (SPD) and factor-based psychological distress scores were analyzed by multivariate linear and logistic regression. Results: The prevalence of SPD was 8.0% for the LGB population aged ≥18, 7.0% for gay and bisexual males, and 8.9% for LGB females, compared with 3.4% for the total straight/heterosexual population, 2.7% for straight males, and 4.0% for straight females. Mean psychological distress index scores were highest among LGB females (109.8), followed by gay and bisexual males (105.8), straight females (100.6), and straight males (97.7). Compared with the straight population, LGB adults had higher education, unemployment, and poverty levels and were more likely to be non-Hispanic White and single. LGB adults were more likely to smoke and drink alcohol and more likely to be physically active than straight adults. LGB females had higher obesity but gay and bisexual males had lower obesity rates than their straight counterparts. After controlling for covariates, LGB adults had 89% higher odds of SPD and significantly higher distress levels than straight adults. Younger age, lower-income, divorce/separation, lack of health insurance, functional limitation, smoking, physical inactivity, and obesity were significant predictors of SPD and higher psychological distress levels in LGB adults. Conclusion and Implications for Translation: Significant disparities in mental health exist, with LGB adults at substantially increased risk of psychological distress and likely in greater need of appropriate social and mental health services. Health policies aimed at improving the material conditions and social environments may lead to improved mental health outcomes among LGB adults and the general population. Copyright © 2022 Singh, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Food Insecurity among Lesbian, Gay, Bisexual, and Transgender Adults During the COVID-19 Pandemic in the United States, July-October 2021

Background: The lesbian, gay, bisexual, and transgender (LGBT) population makes up approximately 6% of the total United States (US) population. Levels and patterns of food insecurity in the LGBT population during the COVID-19 pandemic compared with the general population are unknown. This study examines prevalence and sociodemographic correlates of food insecurity among LGBT and straight/heterosexual adults in the US. Methods: Using the US Census Bureau’s Household Pulse Survey from July to October 2021 (N=372,542), differentials in food insecurity according to LGBT status were analyzed by multivariate logistic regression. Results: The prevalence of food insecurity during the pandemic was 25.6% for transgender adults aged ≥18, significantly higher than that for lesbian/gay adults (11.6%), bisexual adults (13.5%), and straight/heterosexual adults (7.8%). Compared with the straight/heterosexual population, LGBT adults had lower education and income levels and higher unemployment and were more likely to be non-Hispanic White and single. Transgender adults were particularly disadvantaged with respect to socioeconomic status, job loss, and lack of health insurance. After controlling for socioeconomic and demographic covariates, lesbian/gay, bisexual, and transgender adults experienced, respectively, 36%, 35%, and 157% higher odds of food insecurity than straight/heterosexual adults. Black/African American, Hispanic, and mixed-race/ethnicity, lower education and income, lack of homeownership, divorce/separation, lack of health insurance, and recent job loss were significant predictors of food insecurity among LGBT adults. Inequalities in food insecurity by LGBT status were similar in large metropolitan areas. Conclusions and Implication for Translation: Significant disparities in food insecurity exist withLGBT adults, particularly transgender adults, at substantially increased risk of experiencing food insecurity, economic hardship, and social disadvantage during the pandemic and likely in greater need of social and public assistance. Health policies aimed at improving the social and material conditions may lead to improved food security and health outcomes among LGBT adults and the general US population. Copyright © 2022 Singh et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Racial/Ethnic Disparities in Preeclampsia, Eclampsia, and HELLP Syndrome Hospitalizations Rates in the United States

There is a lack of recent data demonstrating how racial/ethnic disparities in the occurrence of preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome may translate into hospitalization rates. Therefore, the purpose of this study was to evaluate the disparities in preeclampsia, eclampsia, and HELLP syndrome hospitalizations rates across racial/ethnic patient populations in the United States (US). The Nationwide Inpatient Sample (NIS) datasets 2016-2018 were used for this analysis. Prevalence rates were calculated for each hypertensive disorder of pregnancy – preeclampsia, HELLP syndrome and eclampsia, by race/ethnicity. Survey logistic regression model was utilized to find the association between race/ethnicity and each phenotype of hypertensive disorder of pregnancy. During the study period, there were 499.4, 27.0 and 12.1 per 10,000 hospitalizations with preeclampsia, HELLP syndrome and eclampsia. The hospitalization rates and odds of a diagnosis of preeclampsia and eclampsia were higher in Non-Hispanic (NH)-Black pregnant population when compared with NH-White pregnant population. The hospitalization rate and odds of having a diagnosis of HELLP syndrome were highest in NH-Whites as compared to other racial/ethnic groups. Copyright © 2022 Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Examining Trends in Black-White Disparity in Traumatic Spinal Cord Injuries among Pregnancy-Related Hospitalizations in the United States

The proportion of women with traumatic Spinal Cord Injuries (tSCI) is increasing globally, yet there is a dearth of data in the literature on female-specific health conditions, such as pregnancy, in this population. In this retrospective cohort study, we sought to fill the gap in the literature regarding racial differences in the trends of tSCI among hospitalized pregnant women. Using Nationwide Inpatient Sample data, all hospitalizations among pregnant women with tSCI were identified. Joinpoint regression analyses were utilized to examine the temporal trends in the rates of tSCI among the entire pregnant hospitalized population in the US during the 10-year study period of 2009-2018. We compared the tSCI hospitalization trends between non-Hispanic (NH) Blacks and NH-Whites. Overall, there was an increase in the rates of tSCI in the entire pregnant population, during the study period (Average annual percentage change [AAPC]: 7.1, 95% CI: 1.2, 13.4). The rates of tSCI were consistently higher in NH-Blacks in comparison to NH-Whites. More public health policies should be directed at preventing acute tSCIs during pregnancy and physicians should understand how to meet the needs of pregnant patients with tSCI, especially those who belong to racial/ethnic minority groups. Copyright © 2022 Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Sex and Age-Based Differences in Adult Acute Myeloid Leukemia Hospitalizations in the United States, 2009-2018

Acute myeloid leukemia (AML) represents the fifth-worst five-year overall survival by cancer type in the United States, and the prognosis is shown to vary by age and sex. However, published data exploring temporal trends in the rates of hospitalization by sex and prognosis patterns incorporating both age and sex remains limited. Therefore, we investigated trends of acute myeloid leukemia (AML) hospitalization rates by sex and the differences in the AML hospitalization rates by sex and age in the adult population using the Nationwide Inpatient Sample database for the years 2009-2018. We examined the differences in rates of AML hospitalizations by sex and age. Next, we stratified the study duration into two groups of five years each: 2009-2013 and 2014-2018 and examined the differences in age and sex across the study period and groups. Pearson’s chi-squared tests were conducted to determine the statistically significant differences in these bivariate comparisons. Overall, during the entire study period, we observed an increased rate of hospitalizations in males, when compared with their female counterparts. The highest AML hospitalization rate for both males and females was observed in the age group of 60-79 years; males accounted for 33.8 per 10,000 hospitalizations and females accounted for 23.3 per 10,000 hospitalizations. The greatest difference in hospitalization rates by age group and sex was observed in 18-39 years (males: 23.6 per 10,000 hospitalizations, females: 7.7 per 10,000 hospitalizations [p-value=<0.01]). The trend in the prevalence of AML hospitalizations by age or sex remains unchanged irrespective of the 5-year study period group. The results from this study would prove vital in directing the decision-making process for healthcare providers and AML patients alike as they work in tandem to navigate the complexities of AML and everything it entails. Copyright © 2022 Dongarwar et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Individual and Community Level Factors Related to HIV Diagnosis, Treatment, and Stigma in Kumasi, Ghana: A Field Report

The human immunodeficiency virus (HIV) is a public health issue globally and in Ghana. While efforts are underway to reduce HIV prevalence in Ghana, there are still some HIV-related issues (duration lived with HIV, mode of HIV diagnosis, HIV status disclosure, HIV treatment, HIV knowledge, and HIV prevention and stigma) that need to be addressed. The purpose of the field study was to examine individual and community level factors related to HIV diagnosis, treatment, and stigma in Kumasi, Ghana. Specifically, we conducted a field-based comparison of HIV-related issues in Kumasi and the US to determine areas of similarities and differences. Since our focus was the Kumasi district in general, and the Suntreso Government Hospital in particular, we used convenient sampling. Thus, study results are not generalizable to the entire population of Ghana. Given the short duration of the entire field study (three weeks) and the fact that most information on the HIV-related issues focused in Ghana are available in the US, secondary data from various sources were used for the US comparison. Results from the study showed that 29.2% of participants in Kumasi had lived with HIV for seven or more years, while data from the US showed that people generally live with HIV for 20 years or more after testing positive for the disease. Most of the study participants in Kumasi (68.5%) stated that they were diagnosed with HIV through a laboratory blood sample test, while rapid antibody and ELISA (enzyme-linked immunosorbent assay) tests were found to be the most commonly used methods in HIV diagnosis in the US. The majority of participants living with HIV in Kumasi (71.7%) and the US (67%) were concerned about their friends and family knowing of their HIV status. Unlike the US where patient assisted programs administered by pharmaceutical companies offer free to lowly priced HIV medication to low-income people living with HIV (PLWH), 92.7% of PLWH in Kumasi had free access to HIV medication. HIV-related stigma was an issue in both Kumasi and the US. Copyright © 2022 Mosley et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Individual and Community Level Factors Related to Contraceptive Access, Family Planning, and Reproductive Health Challenges Among Women in Kumasi, Ghana: A Field Study

Despite the availability of contraceptives, cultural practices and social factors create barriers that prevent women in Ghana from realizing their reproductive health potential. The purpose of the field study was to examine individual and community level factors related to contraceptive access, family planning, and reproductive health challenges among women in Kumasi, Ghana. Specifically, we conducted a field-based comparison of women’s health-related issues in Kumasi and the US to determine areas of similarities and differences. Since our focus was Kumasi in general and the Suntreso Government Hospital in particular, we used convenience sampling. Thus, study results are not generalizable to the entire population of Ghana. Given the short duration of the entire field study (three weeks), and the fact that information on the women’s health areas of focus in Ghana is available in the US, secondary data from various sources were used for the US comparison. Utilizing a cross-sectional, mixed-methods study design, 100 women of reproductive age were surveyed. Results showed that 69.0% of study participants in Kumasi knew where to go to access birth control services but had little desire to use them. Like the study participants in Kumasi, most women in the US also know where to access reproductive health services but are more desirous and interested in using such services. We also found that while cultural norms and gender roles served as primary barriers to family planning and contraceptive access for women in Kumasi, access to health insurance is the barrier in the US. Copyright © 2022 Gibson et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

A Qualitative Exploration of Perceptions of the COVID-19 Vaccine in the United Kingdom During the Later Stages of the Vaccine Rollout

Background and Objective: Although COVID-19 vaccine uptake in the United Kingdom (UK) has been encouraging, many individuals are either hesitant to get vaccinated for COVID-19 or refuse to do so. Research has uncovered associated demographic and psychological factors, but there is a lack of qualitative work involving individuals across the UK to explore reasons for this hesitancy. We aimed to qualitatively explore perceptions of the COVID-19 vaccine in individuals across the UK during the latter stages of the vaccine rollout. Methods: Free-text responses were collected within an online survey assessing factors associated with COVID-19 vaccine acceptance. In total, 861 individuals took part (156 males, 698 females, 1 non-binary, 6 preferred not to say); 217 provided free-text responses. The mean age was 42.04 (SD = 13.20). Six hundred thirty-one respondents (73.3%) had been vaccinated, and 230 (26.7%) had not. An inductive thematic analysis was conducted. Results: Five themes were yielded, describing fear as a vaccination barrier; perceptions of the COVID-19 vaccine being ineffective, unnecessary, unnatural, and experimental; perceived pressure to get vaccinated; practical barriers to getting vaccinated; and getting vaccinated to protect others and ‘get back to normal.’ Conclusion and Implications for Translation: Measures to increase COVID-19 vaccine uptake should target misinformation, fear, and practical factors as deterrents. Interventions such as motivational interviewing should be considered for guiding individuals towards considering COVID-19 vaccination. Copyright © 2022 Eberhardt and Ling. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Building Physician-Scientist Skills in R Programming:A Short Workshop Report.

Introduction:Statistical analysis programs require coding experience and a basic understanding of programming, skills which are not taught as part of medical school or residency curricula.Methods:We conducted a five-day course for early-career Nigerian physician-scientists interested in learning common statistical tests and acquiring R programming skills. The workshop included didactic presentations, small group learning activities, and interactive discussions. A baseline questionnaire captured participant demographics and solicited participants’ level of confidence in understanding/performing common statistical tests. REDCap questionnaires were emailed to obtain feedback on educational format and content. A post-workshop assessment covered participants’ overall impression of the program.Results:A total of 23 participants attended the program. Most participants were male (n=14, 60.9%) and at an early stage in their career (assistant professor, n=20, 87.0%). Approximately 70% of respondents indicated having received some prior training in statistics. The proportion of participants without experience using R and SAS software (90% and 85%, respectively) was greater than the corresponding proportions for Stata (55%) and SPSS (20%). Prior to the workshop, most respondents expressed being “not at all confident” in performing one-way ANOVA (60%), logistic regression (68%), simple linear regression (60%), and McNemar’s test (80%). There was a statistically significant post-workshop improvement in the level of confidence in understanding and performing common statistical tests. The course was rated on a 0–100 scale as “moderately difficult” (mean ± SD: 51.7 ± 19.5). Most participants felt comfortable in putting the knowledge learned into practice (82.2 ± 17.1).Conclusion and Public Health Implications:Introductory R can be taught to junior physician-scientists in resource-limited settings and can inform the development and implementation of similar training initiatives in analogous settings.

Transitioning a Public Health Study Abroad Program to Virtual Format During the COVID-19 Pandemic: Implications for Public Health Practice

High impact learning practices (HIPs) are practices that promote deep learning through student engagement. They focus on the knowledge, attitudes, and skills college students need to succeed academically and professionally and afford students the opportunity to participate in activities beyond the classroom, resulting in learning and personal development. HIPs take various forms and include study abroad, signature experience, first-year seminars, and learning communities. As part of its HIPs, the Georgia State University (GSU) School of Public Health (SPH) offers students the opportunity to study abroad every summer under the auspices of faculty. However, in the summer of 2021, all GSU SPH study abroad programs, including my program, Field Study of Contemporary and Emerging Public Health Issues in Ghana: A Focus on Water and Sanitation, HIV, and Women’s Health Program, were canceled due to the COVID-19 pandemic. Owing to student continued interest, it was imperative to devise a creative method to ensure that students received a comparable experience despite the pandemic. This paper documents the transitioning of a three-week program to a virtual synchronous format to give students the opportunity to work with and learn from in-country partners in Accra, Ghana. The activities, challenges, and lessons learned from transitioning the program are also shared. Overall, students and in-country partners completed three comparative field studies that explored issues related to water and sanitation, the human immunodeficiency virus (HIV), and women’s reproductive health in Ghana. Students and partners identified and reflected on areas of similarities and differences between Ghana and the United States on the public health issues they focused on in the field. Copyright © 2022 Maiyaki et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Individual and Community Level Factors Related to Sanitation, Water Quality, Treatment and Management in Rural Communities in Accra, Ghana: A Field Study Report

Access to safe drinking water and adequate sanitation are basic necessities of life, yet not everyone in the world is able to access these services, particularly people living in rural areas. Rural areas in Ghana, defined as communities with populations less than 5,000 people, and some rural areas in the United States (US), defined as non-metropolitan communities, experience water and sanitation-related issues to varying degrees. The purpose of the field study was to examine individual and community level issues related to sanitation, and water sources, water quality, treatment and management, water needs and water-related illness in Accra, Ghana, and to determine areas of similarities and differences with the US. Thus, study results are not generalizable to the entire population of Ghana. Given the short duration of the entire field study (three weeks) and the fact that most information on water and sanitation in the US is publicly-available, secondary data from various sources were used for the US comparison. Results from the study showed that 61.4% of study participants in the selected communities in Accra and 80.0% of Americans living in rural areas had access to safe water. Lack of access to toilet facilities was minimal in rural communities in both Ghana and the US. Copyright © 2022 Willis et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.